Provider Demographics
NPI:1417977711
Name:VIRGINIA REPRODUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:VIRGINIA REPRODUCTIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHARARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-437-7722
Mailing Address - Street 1:11150 SUNSET HILLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5360
Mailing Address - Country:US
Mailing Address - Phone:703-437-7722
Mailing Address - Fax:703-437-0066
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-437-7722
Practice Address - Fax:703-437-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA239716OtherANTHEM PROVIDER #